The Duke University Medical Center Ischemic Heart Disease Specialized Center of Research is a multidisciplinary, interdepartmental, clinical and fundamental research program directed at reduction of death and disability from ischemic heart disease. Specific projects include assessment of the clinical course of patients with angina pectoris and acute myocardial infarction and assessment of the effectiveness of aortocoronary bypass surgery in modifying the outcome. The diagnostic and prognostic significance of exercise induced left ventricular dysfunction as assessed by radionuclide angiocardiography is being evaluated as is the role of echocardiographic techniques in quantitating ventricular wall motion. Other clinical projects are investigating the effects of prolonged exercise training on ventricular function and the use of surgical procedures for the treatment of refractory ventricular arrhythmias. Fundamental research is being carried out on various aspects of myocardial cell metabolism, the effects of ischemia on cellular metabolism and the pharmacokinetics of antiarrhythmic agents in the ischemic myocardium.